Account Resolution Specialist

ScionHealth; Louisville (KY); On-site; USD 35,000 - 45,000; Full time

Job summary

A leading healthcare organization is seeking an Account Resolution Specialist to support accounts receivable resolution. The role involves researching claims, collaborating with insurance payers, and managing appeals effectively. Ideal candidates will have strong problem-solving skills and at least two years of healthcare collections experience.

Qualifications

• At least 2 years of healthcare collections experience.

Responsibilities

• Support A/R resolution by researching claims and working with insurance payers.
• Review unpaid claims and collaborate with payers to resolve issues.
• Develop and submit detailed appeals based on payer guidelines.

Skills

Research

Problem Solving

Communication

Multitasking

Attention to Detail

Education

High School Diploma

Job description

Join to apply for the Account Resolution Specialist role at ScionHealth

Get AI-powered advice on this job and more exclusive features.

Description

At ScionHealth, we empower our caregivers to do what they do best. We value every voice by caring deeply for every patient and each other. We show courage by running toward the challenge and we lean into new ideas by embracing curiosity and question asking. Together, we create our culture by living our values in our day-to-day interactions with our patients and teammates.

Job Summary

• The Account Resolution Specialist will support A/R resolution in our Central Business Office by researching claims and working with insurance payers to ensure timely account adjudication.
• The ideal candidate can recognize and resolve issues, interpret contract terms for proper accounts receivable management, and process underpayment appeals.

Essential Functions

• Review unpaid claims, identify reasons for delays, and collaborate with payers to resolve issues.
• Follow up on unpaid or denied claims and appeals.
• Research payer denials related to referrals, pre-authorizations, non-covered services, and billing issues; initiate appeals appropriately.
• Develop and submit detailed appeals based on review and payer guidelines.
• Review accounts and aging reports, process adjustments, and manage A/R effectively.
• Respond promptly to insurance requests for documentation.
• Communicate with the Business Office Director about relevant issues.
• Track trends and work across multiple systems daily.
• Review EOBs for errors, denials, and low reimbursements.
• Make regular calls to insurance companies for claim follow-up.
• Research receivables for Medicare and Non-Medicare collections.
• Conduct thorough account research and reconcile discrepancies.
• Document actions taken, process refunds, and monitor insurance coding.
• Identify revenue impacts and underpayment variances, and work on denials.
• Read insurance contracts and monitor claims accordingly.

Knowledge, Skills, and Abilities

• Research, analyze, and resolve problems effectively.
• Multitask efficiently and communicate clearly.
• Use judgment to recognize and address issues independently.
• Work proactively, take initiative, and manage priorities.
• Be a team player with ownership and accountability.
• Pay attention to detail, stay organized, and motivated.

Qualifications

• High School Diploma required.
• At least 2 years of healthcare collections experience.

Additional Information

• Seniority level: Entry level
• Employment type: Full-time
• Job function: Other
• Industry: Hospitals and Health Care